Outcome of a Series of Patients with Pseudomyxoma Peritonei Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy at a Tertiary Cancer Centre in India
Abstract
INTRODUCTION: Cytoreductive surgery (CRS) and
hyperthermic intraperitoneal chemotherapy (HIPEC) is now
the standard of care for the treatment of pseudomyxoma
peritonei (PMP). MATERIALS AND METHODS: This is a
retrospective study of a consecutive series of patients with
PMP treated in our institute from July 2012 to July 2016,
with CRS and HIPEC. CRS consisted of standard
peritonectomy procedures while Mitomycin-C was used for
HIPEC at a dose of 30-35 mg/m2, circulated in the
peritoneal cavity admixed in peritoneal dialysate fluid for
a duration of 60 or 90 minutes, while maintaining a
temperature of 41 to 42 degrees Celsius throughout, using
the closed technique. RESULTS: A total of 13 patients
with PMP were treated during this time period. The median
age of the patients was 55 years (range was 36 to 68
years). The median peritoneal cancer index (PCI) score
was 30 (range 0-39). Completeness of cytoreduction (CC)
score CC0 was achieved in 8 cases and CC1 in 5
cases. The median duration of surgery was 13 hours
(range 6-17 hours). The median blood loss was 1500 ml
(range 200 to 9400 ml). The median duration of stay in the
ICU was 6 days (range 0 to 20 days) whereas the median
duration of hospital stay was 16 days (range 10 to 54
days). Overall morbidity rate was 61.54% with grade III
and IV Clavien-Dindo morbidity seen in 23.08%
cases. There was only one 30-day postoperative mortality
(7.69%). 84.62% patients are alive without recurrence after
a median follow up of 25 months (range 1-57 months).
CONCLUSION: CRS and HIPEC for PMP is a complicated
procedure that should be done in specialized centres, in
which case it is associated with acceptable morbidity and
mortality and good oncological outcomes.
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